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If the Vauto doesn't help I give up on CPAP
#51
RE: If the Vauto doesn't help I give up on CPAP
(12-20-2019, 10:29 PM)ApneaQuestions Wrote: FYI: Some factual data relating to the assertion or assumption that "you have to rent a PAP machine first"...

I can and DID buy my CPAP machine (HCPC code E0601) using my insurance - I did it 3 months ago.  No rental was necessary.
I can and DID buy my BIPAP machine (HCPC code E0470) using my insurance - I did it 4 days ago. No rental was necessary.

I was NOT forced to rent them first.

However, I could NOT buy my "BIPAP & Backup Rate" machine (HCPC E0471) - I could only rent it - so I declined.

Why they made an exception with the advanced machine was somewhat of a mystery to me at first..  but having thought further...my best guess is due to the contra-indications for people with heart issues.  If you give someone a lifetime ownership of that machine and they subsequently develop the heart complaint you can do them harm. By insisting on a rental it gives the opportunity to retrieve the machine if it later becomes necessary or wise.

You've had pretty good cooperation from your insurer.  I think you're on the right track, and a E0471 (ASV) is dependent on both medical necessity and thanks to SERVE-HF a clear ECG that shows you are not in a risk group with LVEF < 45%.  I think we are on our way to debunking that study and ADVENT-HF should be available sometime next year.  Rentals are a way of increasing costs and transferring costs to the patient when they are 13 months. That ensures that deductibles are applicable in two coverage years.  A 3-month rental seems more reasonable because compliance is demonstrated in that period.  Ironically, diagnostic tests cost as much as the machine itself, and the system seems to keep people going back for more testing to demonstrate the need for a particular treatment. Machine data is totally disregarded, which sucks money out of patient's pockets and pays the special interests that created the rules. Even more interesting is that it is often easier to get a surgery that costs $100K rather than a machine that costs $5K.
Sleeprider
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INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.
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#52
RE: If the Vauto doesn't help I give up on CPAP
(12-20-2019, 11:05 PM)Sleeprider Wrote:
(12-20-2019, 10:29 PM)ApneaQuestions Wrote: ...I was NOT forced to rent them first...

You've had pretty good cooperation from your insurer...
Is it OK to mention providers around here or is that discouraged?
I have an explanation as to why I think I got good cooperation but would need to mention the provider involved.
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#53
RE: If the Vauto doesn't help I give up on CPAP
Feel free to mention DME provider names or insurance company names, that's fine.   (more info in the Commercial Links Policy HERE).

We just need to avoid posting direct commercial links to any websites they own or operate.  We have some online DME providers on the Supplier List, which is linked up at the top brown menu area of every forum page... and you can get folks to those providers by simply posting "I use Supplier #1" or something like that.

But you can mention supplier names like Apria, Lincare, etc. no problem.  Same with insurance companies.

Smile
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.


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#54
RE: If the Vauto doesn't help I give up on CPAP
I use Kaiser Permanente.

They are a non-profit organization that does not use an explicit insurance company so there is no need for the doctors to try to convince insurers to pay up.

In my experience so far, if the Doctor feels that something is justified and necessary... it happens.
Their focus seems to be on getting the best clinical outcomes instead of maximizing profits... after all... they don't have profits.

They are as close to a single-payer single-provider system that I could find in the US.

I have had incredible cooperation with each and every doctor and specialist that I have seen.
The Kaiser approach is to encourage patients to be well-informed working with their doctors as a collaborative team.

I can email my doctors and specialists at any time and I usually get a response the same day.
I can self-refer to any specialist without needing referrals from a General Practitioner. That includes physiotherapy and probably includes psychotherapy too.

Most of my prescription requests were done without needing to see the doctor face-to-face. 
They have online chat services, email services, video-link services and (if you prefer) you can see them face to face.. but you are not forced to. 
They are not interested in billing for office visits because there is no insurance company to bill.  If the patient is happy with rapid email turnaround.. they are too.
The doctors are employees and they earn their salary without needing to find ways to do extra billing.  The facilities are sparkling and new.

I sent my Doctor an email attaching OSCAR data and a narrative telling her what to look for and a logical reasoned argument why I felt a different machine would be beneficial.
She sent that email to a colleague to validate the argument and then immediately approved the prescription with an option for me to purchase or rent at my own discretion.
I also asked for a paper lifetime prescription in case I ever switch providers and she did that immediately too without hesitation.

Anything that I feel I need (with a convincing argument explaining why) I get. It's that simple.
Isn't that the way it's supposed to be?
Oh.. BTW.. The DME is Apria. The prescriptions are always "fill as written" so no games downgrading to brick machines either. The machines are all from the top recommended list on the forum. Kaiser have a stock of loaner machines too which they will lend you for a week or so to see if the machine is suitable for you.. at no charge.
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#55
RE: If the Vauto doesn't help I give up on CPAP
Hi, all dear folks

As a great great fan of Dr. Steven Park, I am afraid it might not be fair with him some points I read above. Park's Sleep Interrupted book and his derivative articles, lectures, and interviews on sleep-breathing paradidm were among those most interesting and invaluable things I ever read in my life. Concerning surgery, while reading and re-reading the book, it has not looked to me Park is biased toward this resource, say, for instance this quotation close to the end of the book:  

The bottom line is that if the problems I described in this book are mainly from a structural or anatomic narrowing, then conservative treatments will only do so much. All the cough medications, expectorants, nutritional supplements, herbal remedies, antibiotics or allergy medications can do is to improve that slight degree of inflammation and swelling, but never really address the problem at hand. With more and more studies questioning effectiveness of over-the-counter cold remedies, and with a good chance that the problem will go away on its own anyway, it’s hard to know if any of these medications help at all. When you do feel dramatically better after taking certain antibiotics, as I explained previously, there may be an alternative explanation for your improvement, besides the anti–bacterial properties of the medication. Regardless, I strongly recommend trying and exhausting all conservative measures first before attempting more aggressive options like surgery. For some people, conservative options like not eating late or changing sleep positions can produce dramatic results."

all the best for everyone.



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#56
RE: If the Vauto doesn't help I give up on CPAP
I understand your frustration sorryiamnormal. You've tried a lot, you've done a lot and your issues still persist. I hope fixing your flow limitations with the vauto machine will help.

I highly recommend you reconsider the bleep dreamport for your mask leaks issue. I know you said you didn't like the look of it and I understand it looks weird, despite that, many people have successfully reduced their leak rate massively with it.
Nothing I post is medical advice and should not be taken as such, always consult a medical professional for guidance.
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#57
RE: If the Vauto doesn't help I give up on CPAP
I hate to drag out this conversation, but I feel it's important for folks to understand how a slick operator like Park works.  He may in fact be a talented surgeon, but that does not mean that he is incapable of using a degree of deception in order to line his own pockets.

To actually see Steven Park's bias, it's important to have a bit of critical thinking and analyze what he actually says, and more importantly what he is not saying.    Keep in mind that the quote from his book was not an accident.  He carefully worded it to bring his readers to a specific pre-determined conclusion or "mindset". For instance, let's take a look at the bolded quote by Dr. Park from a previous post:


Quote:Regardless, I strongly recommend trying and exhausting all conservative measures first before attempting more aggressive options like surgery. For some people, conservative options like not eating late or changing sleep positions can produce dramatic results."


First, please notice that he is giving "lip-service" to the fact that surgical solutions should not be considered as a first option.  If he didn't make this statement, he'd be seen by most people as a "quack".  When attempting to bring his readers to a certain mindset, he must first sound "reasonable" by giving them a factoid that's a very obvious fact -- a fact that any reasonable person would have to agree with.  Most reasonable people would think "Yeah, of course, surgery should never be the first option under any circumstance" (the guy sets himself up as seeming very reasonable to readers by stating such an obvious fact that they will agree with).  He must build that foundation of confidence first.

If he were to start off by giving an outrageous statement that most people would find to be absurd, people would stop reading right then and there.  By making a series of "reasonable-sounding" statements first, he gets his readers into the habit of trusting him, since "he's sounded so reasonable in other areas, so his other statements must be reasonable as well".  This particular method of "trust-building" is common manipulative tool of con-men.

Second, please note what he is not saying in this statement.  He never mentions CPAP in this statement at all.  In fact, he purposefully does not mention CPAP therapy in his examples of "conservative measures".  Ask yourself:  why is that?  There's a reason, and the reason is that CPAP is the gold standard for most sleep apnea patients.  It works well for most people who continue to use it, and he knows that.  But the end goal of promoting his surgery over CPAP would necessitate that he stack the deck of other "solutions" in a way that doesn't even give CPAP as one of the optional "conservative measures".  Instead, he completely omits the most popular solution (CPAP).  Hmm....

Also, what are the "conservative measures" that he gives as examples?  Let's see... they are 1) not eating late and 2) changing sleep positions.  Seriously?  That's the first two "conservative measures" he mentions as alternatives to surgery?  What about CPAP?  Why in the world would he not mention CPAP?  It's the absolute, hands-down most popular "conservative measure" for treatment of sleep apnea!  I'll tell you why-- it's because he's using slick con-man methods to bring you to a per-determined conclusion.  By introducing other "conservative measures" like changing your diet or your sleep position, he's essentially wanting people who've tried those two options unsuccessfully to come to the conclusion that surgery is the logical next step for them.  No mention of CPAP here.  Sound fishy?  Sure does to me.

And offering two "conservative measures" that are hardly considered by knowledgeable people to be "solid treatments for sleep apnea" is setting up a straw-man argument.  Yes, don't eat late and try a different sleeping position, by all means!  But are those two items serious "sleep apnea treatments"?  No, of course not.  They can help to some degree, but if you truly have sleep apnea, no amount of "not eating late" or "changing sleep positions" will eliminate the vast majority sleep apnea events the way CPAP does.

Just because this doctor "sounds" reasonable in some areas is no reason to cast facts aside and be unwilling to realize that he is trying to steer patients towards the direction of surgical solutions - specifically his surgical solution.  The arguments are slick and many people are fooled by the con-man style logical progression.  Yep, you can find quotes all day long from him where it "appears" like he's "okay" with CPAP treatment.   Again, to be a successful con-man, a person must tell mostly a bunch of truths to gain your "confidence" prior to introducing the pre-determined solution that will "solve all your problems".

The sad part is that these types of arguments are most successful in the people who are desperate for anything that gives them a slight glimpse of hope.  Their own inflated desire and desperation for something -- anything to work opens them up to these types of arguments.  As long as there are desperate people, there will be con-men willing to take advantage of their vulnerabilities.  And that type of deception isn't limited to the shell-game operators on the street; it exists in just about every profession, including the "professionals" who wear white coats.

Caveat emptor.

Cool
SuperSleeper
Apnea Board Administrator
www.ApneaBoard.com


INFORMATION ON APNEA BOARD FORUMS OR ON APNEABOARD.COM SHOULD NOT BE CONSIDERED AS MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF A PHYSICIAN BEFORE SEEKING TREATMENT FOR MEDICAL CONDITIONS, INCLUDING SLEEP APNEA. INFORMATION POSTED ON THE APNEA BOARD WEB SITE AND FORUMS ARE PERSONAL OPINION ONLY AND NOT NECESSARILY A STATEMENT OF FACT.


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#58
RE: If the Vauto doesn't help I give up on CPAP
Exactly  like
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